December 2025

A greater proportion of patients with type 1 diabetes who used automated insulin delivery systems vs multiple daily injections achieved the Healthcare Effectiveness Data and Information Set (HEDIS) glycemic measure.

This study found that certain characteristics in linked electronic health record data across episodes of care can help identify patients with Alzheimer disease and related dementias at high risk of 30-day readmissions.

Limiting health-related social needs screening to lower-income areas would reduce screening burdens; however, this study found a 2-stage screening approach based on geography to be suboptimal.

Medicaid’s Institution for Mental Diseases (IMD) rule bars federal funding for psychiatric facilities with more than 16 beds, but findings indicate that state waivers allowing treatment of serious mental illness in IMDs do not increase overall psychiatric hospitalizations.

The foundation of medically integrated pharmacy includes 7 critical pillars. This commentary focuses on the benefits of 3 of those pillars: abandonment, adherence, and access/affordability.

Two-thirds of pharmaceutical companies did not proactively release the launch price of their medications from 2022 to 2024.

Most Medicare beneficiaries perceived low health care burdens, but 1 in 4 Medicare Advantage enrollees with at least 6 chronic conditions experienced high administrative and financial burdens.

Self-pay emergency department prices rose significantly from 2021 to 2023, especially at for-profit and system-affiliated hospitals, highlighting growing affordability challenges for uninsured and underinsured patients.

Connecting primary care providers and commercially insured adults to outpatient behavioral health services via a digital platform improved health outcomes and reduced medical costs.

This commentary proposes a hybrid drug pricing reform model balancing most favored nation (MFN) benchmarking with domestic negotiation strategies that drive equity-focused valuation frameworks.

To mark the 30th anniversary of The American Journal of Managed Care (AJMC), each issue in 2025 includes a special feature: reflections from a thought leader on what has changed—and what has not—over the past 3 decades and what’s next for managed care. The December issue features a conversation with AJMC Co–Editors in Chief A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design and a professor at the University of Michigan in Ann Arbor; and Michael E. Chernew, PhD, the Leonard D. Schaeffer Professor of Health Care Policy and the director of the Healthcare Markets and Regulation Lab at Harvard Medical School in Boston, Massachusetts.

Medicare Advantage beneficiaries with mental health diagnoses see more nurse practitioners and fewer internal medicine and emergency medicine specialists after switching to traditional Medicare.

Supported value-based care improves prenatal care while reducing neonatal intensive care unit stays, preterm birth rates, low birth weight rates, and costs for mothers and infants.